port accessing tips.

[busybee04]

Hi,

I am fairly new to the oncology field, and have minimal experience accessing ports. I have successfully accessed ports in the past, however, I did miss the last two ports I attempted to access (not sure if I hit the edge). I do take my time feeling for the port. Maybe my more experienced nurses have some tips they would like to share so I more efficient in accessing ports.

[IVRUS, BSN, RN]

knoxnurse236 said:

When you get the skill down its so much easier to access and change port needles then placing an iv. I work on an inpatient chemo floor so the majority my patients have ports. I worry more about sterile technique, sticking is easy. Feel for the bumps, have your patient lay flat and really hold the port in place. When changing the needle look for the old stick marks for guidance. Also know the difference between a power and regular port. The right size needle is key. 3/4 inch for most patients and 1 inch for patients who are larger. Although sometimes that rule doesn't always apply, always look in the chart to see what was used previously.

As stated, not all implanted ports have "bumps" surrounding the septum. Only Bard's power injectable ports have them that I know of. So, don't freak out when you're accessing port, and can't find the bumps. Also, do NOT place the needle into the previous "hole". Reaccess next to, or on the side of the previous area of needle placement. The right length needle is important, as you want to be able to hit the bottom of the septum, but also to have the wings of the port needle lie flat against the patient's skin. But the gauge is important also as the smaller gauges will save on the life of the port.

[emtb2rn, BSN, RN, EMT-B]

Agree with asytole, hold the port itself. Keep it from sliding sideways. Also, if you don't get blood in the tubing for your waste, pull the needle up a mm or so.

[Caffeine_IV]

Great tips. I always inspect the port with clean hands before I do the sterile stuff.

The deep ports still give me issues but holding it stable and stretching the skin taut often helps.

[OCNRN63, RN]

I used to have people take a breath. It may not make the stick easier, but it serves as a distraction technique; while the patient is busy thinking about taking the breath, you can stick.

Now that I'm on the receiving end of port sticks, I have to say I find myself taking a deep breath, even if the nurse doesn't remember to tell me to do so. In fact, I used to take a deep breath when I was the one doing the sticking, LOL!

[Clarepaedoncuk]

My advice is stabilise the port with your non dominant hand. And aim dead centre of the middle of the port and push hard, you will feel it "give". Usually there are scars where the port has been accessed in the past. Aim for those too. But stabilisation is key to accessing a port first time

[marialsnd]

When I get my own port accessed or when I access a patient's port, I have them inhale and hold their breath. I feel like it helps to bring the port a little farther forward, plus it is a little more stabilized on the inside with the lungs expanded. As many have already posted, don't be timid when accessing. If you hit the side and slide off the edge, you can pull back slightly without the needle coming out and becoming locked so that you can slightly readjust the angle of insertion. If the port is slightly tipped, if you push on the opposite side it will help to bring the tipped side up (I know this from personal experience because my port is tipped and that is how I can feel all 3 bumps indicating placement and is how others are able to access it.

[pshiffman55]

Thank you SO much for this thread!!! Not all ports are created equally..... I am new to them, and know what I'm doing, but lack the actual experience. I've mostly dealt with peripheral and PICC's, and today I had a real issue with a power port. I just knew I was in the right place, but couldn't get a blood return, and it wasn't typical for this patient. Fortunately, she was an angel, and let me try a few times. I definitely had luck when I went from a 22 gauge to a 20 gauge.....that was my experience, and she infused for 3 hours in her house with no problems. But I really was feeling horrible when I couldn't get her right away and her port felt so funky. I really had to feel for the very small area of Squish in her port. I love all the other suggestions. OH, and in my experience with PICC's (not talking ports)...I've used heparin until we could get some Cathflo out to the house, and the patient swore it worked, albeit temporarily. I know about the fibrin build-up, but it has been a temporary fix for patients, at least with so many PICC's I've worked with, and I won't accept any flick on the head-- it does what it does. Anyhow, THANK YOU ALL!!! I do home health infusions and sometimes I feel like a superhero and other times like I'm still a student!

[kystakreeves]

I hear y'all talk about stabilizing the port however there are some folks with a floating port and if you hold it it's kind of like trying to hold a bar of wet soap the harder you grasp the more it moves. I have found if you gently stabilize with non dominant hand and as several have said just push it in fast that works well. I work as a psych nurse and have worked on a lock down unit same theory show no fear and once you've found it go for it. Patients are perceptive and they sense your hesitation don't do that to them most are already scared etc trust yourself.

[Quota, BSN, RN]

Glad to find this thread. I’m a new grad on an Oncology medsurg unit and have been unsuccessful on the three mediport access attempts I’ve made. Leading me to just get more nervous each time because I’ve not been successful yet. After my last attempt I asked a lot of questions about what I could be missing and for more tips to help me be successful next time. The biggest take away I got was about pulling the skin taunt over the port and securing it firmly. Glad to see that echoed here a lot.

Another issue I think I had was not fully grasping just how hard I need to push. Deaccessing my last mediport really brought that point home, really need to secure and pull hard to deaccess. Thanks for sharing your experiences.

[soph85]

Practice, practice, practice. Stabilization is key, especially for the deep ones. My patients have said the way their port sits can change over time, especially if they have lost a lot of weight. If it feels tilted to one side, make sure you push down the opposite side so you hit the circle straight on. You don't have to "stab," just pull skin taut and push with steady pressure. Have patients take a deep breath as distraction. Use lidocaine spray or EMLA cream if they really have a hard time with it (I'm outpatient oncology and I do this for <10% of people, most can handle accession just fine). If you don't get blood return, have them take deep breaths, lie flat, turn their heads and cough, raise the arm on that side, stand up and lean over, etc. Our facility has us instill high dose heparin first for fibrin sheaths which never works, but then alteplase always does.

[Quota, BSN, RN]

It’s been about 6 weeks since I found this thread and posted here but thought I’d share I successfully accessed my first mediport today. Much thanks to this thread and really grasping the importance of pulling the skin taught and firmly stabilizing the port itself. Weird that it took so long for another chance to access another port on my floor but things just hadn’t lined up until today. Only one other day between then and now have I had a patient that needed their port accesses and things just got crazy busy that day and it had to wait for night shift. Felt great to finally get it and feel more confident about the procedure.

Just thought id share my happy ending of today’s shift.

[Meger, ADN]

So once you clean the site and you insert the needle and get blood return what do you do? Just Leave the needle in and tape it? Do you have to pull the needle up or something? Not a lot of experience with accessing ports. More of an IV sticker. Thanks in advance.